Nurse Charged With Homicide

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  1. Should Radonda Vaught, the nurse who gave a lethal dose of Vecuronium to patient at Vanderbilt University Medical Center, be charged with reckless homicide?

    • 395
      She should not have been charged
    • 128
      She deserved to be charged

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Radonda Vaught, a 35 year old nurse who worked at the University of Vanderbilt University Medical Center, has been indicted on charges of reckless homicide. Read Nurse Gives Lethal Dose of Vecuronium

Radonda is the nurse who mistakenly gave Vecuronium (a paralytic) to a patient instead of Versed. The patient died.

57 minutes ago, Wuzzie said:

I appreciate your passion, I really do but let’s line up the sequence of events

Trust me, I know every single missed step she made that's been reported; those missed steps have been given many times among all the related threads, including the one with bolded numbers. I get it. But I don't look at this series of skipped steps in the same way as many of you do. I think she was not experienced enough for helper-nurse role. I think she had too much faith and trust in her bosses and the nurse who delegated to her. I think she failed in all of the ways everyone said she failed to be a good nurse. But I look at her failure as a single (what, 30 min. or an hour?) mindless rush of grab-wrong-med-administer-and-fail-to-monitor mistake. As much as analogies have been used, I hope you'll forgive a short one here: saying the nurse failed eight or more times is, to me, like piecing apart a car wreck so that instead of saying "she wrecked", you say she: #1 failed to brake #2 failed to honk horn #3 failed to turn steering wheel appropriately #4 failed to let off accelerator #5 failed to stay on road, etc. Analogies can be frustrating, but my point is that I see all her failings as one task she was trying to check off her list, however wrong she was to become so mindless in those moments: gave-wrong-med-and-walked-away.

Depending on what led her to behave the way she did, I think that what she did could very well be the actions of a normally prudent nurse. I guess you can so confidently conclude otherwise because you have a lot of experience so can't even imagine accidentally killing someone in the way that she did; she did not have that experience, nor the benefit of hindsight. Basically, I believe in giving her the benefit of the doubt, and you seem to feel you know enough to know she was not normally prudent; that she just didn't care. I don't believe she meets reckless homicide charges because I think she was not aware in those horrible moments, as I explained better in other posts. I don't believe she deserves to be criminalized for how she erred based on facts we know of so far.

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10 minutes ago, Wuzzie said:

I think if even one nurse looks at the things she did wrong, identifies a similarity in their practice and changes it then all this debate is totally worthwhile.

Heck yes, I totally agree with that. And I think also that if even one hospital's powers-that-be reads this and decides to not push nurses into working in unsafe environments, with unsafe work loads, and unreasonable expectations, then this debate is even more worthwhile. You get one nurse to change, maybe you'll save thousands of lives or near-misses; you get one hospital to change, you'll save trillions.

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I think there is much more to the story then just the nurse giving the wrong med. horrible someone lost their life over it but a root cause analysis needs to be done. It’s never just one persons fault IMO. It seems to have gotten through pharmacy, Pyxis, drs, maybe staffing was bad too? I can’t imagine the utter devastation the family or that nurse must feel. ??

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I’m curious to know why you’re so certain that the environment RV was working in was so unsafe or why you think there was a staffing issue. I don’t recall any of that being noted in the CMS report. The fact that one of the nurses was covering for lunch is not indicative of a problem. As I mentioned earlier this is SOP in a lot of ICUs.

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1 minute ago, JLB1215 said:

I think there is much more to the story then just the nurse giving the wrong med. horrible someone lost their life over it but a root cause analysis needs to be done. It’s never just one persons fault IMO. It seems to have gotten through pharmacy, Pyxis, drs, maybe staffing was bad too? I can’t imagine the utter devastation the family or that nurse must feel. ??

When I made my error it was my fault and only my fault. In this situation pharmacy, the Accudose and the Physician did absolutely wrong. There is a link to the CMS report on page 14. It’s mind-boggling.

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2 hours ago, mtnNurse. said:

But I don't look at this series of skipped steps in the same way as many of you do.

The reason it is it is important to look at each step is because that is how we learn safe administration. Step by step, check by check. It's not at all like a car wreck where everything happens in an instant.

If she had done just ONE safety check, she would not have given the patient vecuronium.

And no. You don't go from being a prudent nurse who has occasionally skipped one safety check due to being overworked or overwhelmed or having momentary inattentiveness to one day skipping Every. Single. One.

More likely in her effort to be fast and efficient, she got into a habit of skipping those mundane/repetitive steps. It all caught up with her in the worst possible way, highlighting to everyone why those every single one is so important.

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1 hour ago, Wuzzie said:

I’m curious to know why you’re so certain that the environment RV was working in was so unsafe or why you think there was a staffing issue. I don’t recall any of that being noted in the CMS report. The fact that one of the nurses was covering for lunch is not indicative of a problem. As I mentioned earlier this is SOP in a lot of ICUs.

First of all, I admit I don't know but rather I'm giving that nurse the benefit of the doubt. I think it's highly likely that the environment was unsafe and there was a staffing issue because of many reasons, some of which I already pointed out, e.g. nurse doubling up on patients to relieve another nurse for lunch break (I don't care if you say that is standard practice; that doesn't make it safe IMHO) and my suspicion that resource-nurse was hospital-wide not just for ICU (which we don't know). Other reasons: the hospital I worked in and any other hospital I've ever heard of from other nurses has way less than ideal working conditions and nearly constant understaffing. Recall how I defined understaffing earlier -- I don't care if the floor management says they are staffed appropriately; I care if us less experienced, less than superstar nurses have reasonable work expectations. We don't. Nurses are expected to pull off the impossible with too many patients every day all over this country and people are dying because of it.

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Out of curiosity are you an ICU nurse?

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18 minutes ago, mtmkjr said:
2 hours ago, mtnNurse. said:

But I don't look at this series of skipped steps in the same way as many of you do.

The reason it is it is important to look at each step is because that is how we learn safe administration. Step by step, check by check. It's not at all like a car wreck where everything happens in an instant.

Yes, I agree with you we should look at each step and be conscious when administering, and seeing where mistakes were made and how to learn from them. But as far as her mindless unintentional failing goes and whether it warrants criminality, I see that as a ~30min. single horrific fallacious wrong-med-no-monitor mistake.

18 minutes ago, mtmkjr said:

If she had done just ONE safety check, she would not have given the patient vecuronium.

Yes, if only she had kept on high alert those entire 30 min. or so as we all know she should have.

18 minutes ago, mtmkjr said:

And no. You don't go from being a prudent nurse who has occasionally skipped one safety check due to being overworked or overwhelmed or having momentary inattentiveness to one day skipping Every. Single. One.

Well, not much more we can likely say about that except that you don't agree with me nor I you. IMHO, she could've been the most prudent nurse in the world up until that tragic ~30 min. to an hour, however long those moments were between delegation and walking to ED.

18 minutes ago, mtmkjr said:

More likely in her effort to be fast and efficient, she got into a habit of skipping those mundane/repetitive steps. It all caught up with her in the worst possible way, highlighting to everyone why those every single one is so important.

Yes, every step is very important. I agree. I disagree those actions should criminalize her, and I've described why in other posts.

It sounds like you don't think she was ever a good nurse. We don't know if she was. If you do think she might have at least wanted to be a good worker and needed more lessons on becoming a good nurse...maybe it'd be a good idea for all nurses to get continual education on root cause analysis of fatal mistakes at least once a year? Maybe nurses could be encouraged by their employers to slow down, stay alert, take breaks to stay alert (and give them enough staff to do so), ask for help when needed (and give them enough staff to get the help) -- instead of being encouraged to speed up and take shortcuts and work their tails off 'til their brains are fried? If ideal conditions had been in place, we don't know whether this accidental death would have occurred. Just because some of you could never ever make the same series of step-skipping as she did does not mean that she could not have been prevented from accidentally causing this death, had environment and circumstances leading up to the death been different.

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2 hours ago, Wuzzie said:

I’m curious to know why you’re so certain that the environment RV was working in was so unsafe or why you think there was a staffing issue. I don’t recall any of that being noted in the CMS report. The fact that one of the nurses was covering for lunch is not indicative of a problem. As I mentioned earlier this is SOP in a lot of ICUs.

???

I hear you. It's rotten that they didn't even ask any questions about that, though. If nothing else, what kind of an investigation is that?

If nothing else, why was this apparently 100% inept individual inside this facility, regardless of role?

I am not sure if I agree that something is always NBD just because it is SOP - that's kind of like kids trying to make wise decisions based on what their friends are doing. ? Although I will concede that it was not the major determining factor in this situation as far as my interpretations based on the known facts.

**********

I just still feel this situation is not okay separate from RV and her missteps.

I think there's so much goofiness here that it can't possibly be "all that" on that floor - that's why I tend to think there was chaos and/or very loose practice involved. For example, you don't just have RV, you have at least one other nurse who knows dang good and well she just sent her patient out of the department off monitors (which was fine d/t downgraded status), but then casually sends someone else to administer IV sedative after basically discrediting another department's concerns/requests. So, there's two people who are very comfortable with not doing the right thing.

Sounds kind like typical cowboy crap to me - and that is a culture that, often enough, is a poor/wrong/unfortunate manifestation evolving out of necessity. And by necessity I mean either literal need or else expectations.

And...just as the actions of RV speak for themselves, the actions of any and all personnel who were supposed to refrain from tampering with what was clearly an ME case, and who clearly knew they were supposed to report the incident - all of that also speaks for itself. It's impossible for me to believe all is well in that place. Impossible.

I think there are a lot of very relevant concerns being expressed on the thread, although I stop short of believing that they should have exculpatory bearing upon the outcome of RV's personal situation going forward.

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On 2/17/2019 at 11:26 AM, mtnNurse. said:

I don't think she purposely skipped the five rights and chose to risk the patient's life by not monitoring, as I've gone over many times... I think if her brain had been sharp in those moments, she would not have accidentally killed a patient.

I am not a nurse yet, but the thing that strikes me the most is that the doctors order stated that an ADDITIONAL dose could be given if the first dose wasn't adequate. That suggests to me that this nurse (regardless of the fact that she was giving an IV push medication) needed to stay and monitor her patients response to the medication to verify if she needed an additional dose. She just gave the med and left. I am sorry but that was negligent on her part! Sad to think if she would have stayed how differently this story would have gone.

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Specializes in Psych, Addictions, SOL (Student of Life).
On 2/17/2019 at 4:01 PM, mtnNurse. said:

Trust me, I know every single missed step she made that's been reported; those missed steps have been given many times among all the related threads, including the one with bolded numbers. I get it. But I don't look at this series of skipped steps in the same way as many of you do. I think she was not experienced enough for helper-nurse role. I think she had too much faith and trust in her bosses and the nurse who delegated to her. I think she failed in all of the ways everyone said she failed to be a good nurse. But I look at her failure as a single (what, 30 min. or an hour?) mindless rush of grab-wrong-med-administer-and-fail-to-monitor mistake. As much as analogies have been used, I hope you'll forgive a short one here: saying the nurse failed eight or more times is, to me, like piecing apart a car wreck so that instead of saying "she wrecked", you say she: #1 failed to brake #2 failed to honk horn #3 failed to turn steering wheel appropriately #4 failed to let off accelerator #5 failed to stay on road, etc. Analogies can be frustrating, but my point is that I see all her failings as one task she was trying to check off her list, however wrong she was to become so mindless in those moments: gave-wrong-med-and-walked-away.

Depending on what led her to behave the way she did, I think that what she did could very well be the actions of a normally prudent nurse. I guess you can so confidently conclude otherwise because you have a lot of experience so can't even imagine accidentally killing someone in the way that she did; she did not have that experience, nor the benefit of hindsight. Basically, I believe in giving her the benefit of the doubt, and you seem to feel you know enough to know she was not normally prudent; that she just didn't care. I don't believe she meets reckless homicide charges because I think she was not aware in those horrible moments, as I explained better in other posts. I don't believe she deserves to be criminalized for how she erred based on facts we know of so far.

You keep arguing that this nurse was not experienced enough yet the public record shows that she was licensed in 2015 and has been a nurse for 4 years. While this is not a long time it is certainly enough time to have some seasoning and have developed some good common sense on the job. The other argument is that the hospital had an unsafe working environment or was understaffed. We will never know if that is true as we were not there and the fact that they had a extra help nurse shows that the hospital was trying to alleviate a staffing issue by having an extra nurse on duty to make sure people got breaks and or help where needed.

Hppy

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